{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T01:15:46Z","timestamp":1767143746155,"version":"build-2238731810"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Res Health Serv Reg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Demographic change and the increasing prevalence of chronic illnesses lead to a higher demand for palliative care. Currently, little is known about potential need for palliative care at a small-area level in Germany. However, this is crucial for the planning of services. We aimed to calculate the proportion of the population potentially in need of palliative care on a small-area level and to illustrate the nationwide variations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cross-sectional study based on causes of death statistics in Germany. Causes of death of all adult deceased in Germany in 2022 were included. The potential need for palliative care was identified based on Murtagh et al. (2014) using ICD-10-codes. Geographic variation was analyzed on district level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      1,062,452 persons were documented in the causes of death statistics, of which 752,643 died with a potential palliative care need (70.8%). Overall mean age was 79.5 years (SD 12.7), 50.1% were female (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009532,248). Most deaths were due to neoplasms (23,675; 22.6%) and cardiovascular diseases (230,338, 21.7%). The numbers of deceased with potential need per 100,000 inhabitants varied between districts from 578 to 1,438, with highest values in districts in Saxony, Thuringia, Saxony-Anhalt, and lowest in Bavaria and Baden-Wuerttemberg.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our definition of potential palliative care need included both deaths due to oncological diseases, who commonly receive palliative care, and non-oncological conditions. The findings highlight the regional differences in potential palliative care need on small-area level and the importance of comprehensive healthcare planning adapted to the specific needs of individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43999-025-00070-4","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T06:55:50Z","timestamp":1752216950000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patients potentially in need for palliative care in Germany\u2014A regional small-area estimation based on death registry data"],"prefix":"10.1007","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1930-8745","authenticated-orcid":false,"given":"Daniela","family":"Gesell","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7351-7092","authenticated-orcid":false,"given":"Farina","family":"Hodiamont","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0958-3041","authenticated-orcid":false,"given":"Claudia","family":"Bausewein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0273-7984","authenticated-orcid":false,"given":"Eva","family":"Grill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3203-7188","authenticated-orcid":false,"given":"Daniela","family":"Koller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"70_CR1","unstructured":"World Health Organization (2025) Palliative care. https:\/\/www.who.int\/health-topics\/palliative-care Accessed 2025"},{"issue":"6","key":"70_CR2","first-page":"278","volume":"16","author":"L Radbruch","year":"2009","unstructured":"Radbruch L, Payne S (2009) White paper on standards and norms for hospice and palliative care in europe: part 1. Eur J Palliat Care 16(6):278\u2013289","journal-title":"Eur J Palliat Care"},{"key":"70_CR3","unstructured":"Leitlinienprogramm O (2020) Erweiterte S3-Leitlinie palliativmedizin f\u00fcr patienten Mit einer nicht-heilbaren krebserkrankung. Langversion 2.2. https:\/\/www.dgpalliativmedizin.de\/images\/stories\/pdf\/LL_Palliativmedizin_Langversion_2.2.pdf Accessed 2024."},{"issue":"1","key":"70_CR4","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1177\/0269216313489367","volume":"28","author":"FE Murtagh","year":"2014","unstructured":"Murtagh FE, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ (2014) How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med 28(1):49\u201358. https:\/\/doi.org\/10.1177\/0269216313489367","journal-title":"Palliat Med"},{"issue":"6","key":"70_CR5","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1177\/0269216316671280","volume":"31","author":"L Morin","year":"2017","unstructured":"Morin L, Aubry R, Frova L, MacLeod R, Wilson DM, Loucka M et al (2017) Estimating the need for palliative care at the population level: A cross-national study in 12 countries. Palliat Med 31(6):526\u2013536. https:\/\/doi.org\/10.1177\/0269216316671280","journal-title":"Palliat Med"},{"issue":"6","key":"70_CR6","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1177\/0269216316673550","volume":"31","author":"K Brameld","year":"2017","unstructured":"Brameld K, Spilsbury K, Rosenwax L, Murray K, Semmens J (2017) Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population. Palliat Med 31(6):537\u2013543. https:\/\/doi.org\/10.1177\/0269216316673550","journal-title":"Palliat Med"},{"issue":"7","key":"70_CR7","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1191\/0269216305pm1067oa","volume":"19","author":"LK Rosenwax","year":"2005","unstructured":"Rosenwax LK, McNamara B, Blackmore AM, Holman CD (2005) Estimating the size of a potential palliative care population. Palliat Med 19(7):556\u2013562. https:\/\/doi.org\/10.1191\/0269216305pm1067oa","journal-title":"Palliat Med"},{"issue":"2","key":"70_CR8","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1191\/0269216306pm1112oa","volume":"20","author":"SD Borgsteede","year":"2006","unstructured":"Borgsteede SD, Deliens L, Francke AL, Stalman WA, Willems DL, van Eijk JT et al (2006) Defining the patient population: one of the problems for palliative care research. Palliat Med 20(2):63\u201368. https:\/\/doi.org\/10.1191\/0269216306pm1112oa","journal-title":"Palliat Med"},{"issue":"11","key":"70_CR9","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1089\/jpm.2018.0573","volume":"22","author":"M Panarella","year":"2019","unstructured":"Panarella M, Saarela O, Esensoy AV, Jakda A, Liu ZA (2019) Regional variation in palliative care receipt in ontario, Canada. J Palliat Med 22(11):1370\u20131377. https:\/\/doi.org\/10.1089\/jpm.2018.0573","journal-title":"J Palliat Med"},{"key":"70_CR10","first-page":"183","volume-title":"Health care needs assessment","author":"I Higginson","year":"1997","unstructured":"Higginson I (1997) Health care needs assessment: palliative and terminal care. In: Stevens A, Raftery J (eds) Health care needs assessment. Radcliffe Medical, Oxford, pp 183\u2013260"},{"issue":"3","key":"70_CR11","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1097\/SPC.0b013e328356aaed","volume":"6","author":"X G\u00f3mez-Batiste","year":"2012","unstructured":"G\u00f3mez-Batiste X, Mart\u00ednez-Mu\u00f1oz M, Blay C, Espinosa J, Contel JC, Ledesma A (2012) Identifying needs and improving palliative care of chronically ill patients: a community-oriented, population-based, public-health approach. Curr Opin Support Palliat Care 6(3):371\u2013378. https:\/\/doi.org\/10.1097\/SPC.0b013e328356aaed","journal-title":"Curr Opin Support Palliat Care"},{"issue":"1","key":"70_CR12","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12904-016-0099-2","volume":"15","author":"N Scholten","year":"2016","unstructured":"Scholten N, Gunther AL, Pfaff H, Karbach U (2016) The size of the population potentially in need of palliative care in Germany - an Estimation based on death registration data. BMC Palliat Care 15(1):29. https:\/\/doi.org\/10.1186\/s12904-016-0099-2","journal-title":"BMC Palliat Care"},{"issue":"4","key":"70_CR13","doi-asserted-by":"publisher","first-page":"e0231666","DOI":"10.1371\/journal.pone.0231666","volume":"15","author":"E Chukwusa","year":"2020","unstructured":"Chukwusa E, Yu P, Verne J, Taylor R, Higginson IJ, Wei G (2020) Regional variations in geographic access to inpatient hospices and place of death: A Population-based study in england, UK. PLoS ONE 15(4):e0231666","journal-title":"PLoS ONE"},{"issue":"1","key":"70_CR14","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12942-019-0172-1","volume":"18","author":"E Chukwusa","year":"2019","unstructured":"Chukwusa E, Verne J, Polato G, Taylor R, Higginson IJ, Gao W (2019) Urban and rural differences in geographical accessibility to inpatient palliative and end-of-life (PEoLC) facilities and place of death: a National population-based study in england, UK. Int J Health Geogr 18(1):8","journal-title":"Int J Health Geogr"},{"issue":"13","key":"70_CR15","doi-asserted-by":"publisher","first-page":"2267","DOI":"10.1200\/JCO.2009.23.2850","volume":"28","author":"J Cohen","year":"2010","unstructured":"Cohen J, Houttekier D, Onwuteaka-Philipsen B, Miccinesi G, Addington-Hall J, Kaasa S et al (2010) Which patients with cancer die at home? A study of six European countries using death certificate data. J Clin Oncol 28(13):2267\u20132273","journal-title":"J Clin Oncol"},{"issue":"10","key":"70_CR16","doi-asserted-by":"publisher","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","volume":"12","author":"EI Benchimol","year":"2015","unstructured":"Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I et al (2015) The reporting of studies conducted using observational Routinely-collected health data (RECORD) statement. PLoS Med 12(10):e1001885","journal-title":"PLoS Med"},{"key":"70_CR17","unstructured":"Bundesamt f\u00fcr Kartographie und G (2022) Verwaltungsgebiete der Bundesrepublik Deutschland 1: 2.500. https:\/\/gdz.bkg.bund.de\/index.php\/default\/digitale-geodaten\/verwaltungsgebiete.html?___store=default Accessed 2024"},{"key":"70_CR18","unstructured":"Statistische \u00c4mter des Bundes und der L\u00e4nder (2022) Fl\u00e4che und Bev\u00f6lkerung nach L\u00e4ndern. https:\/\/www.statistikportal.de\/de\/bevoelkerung\/flaeche-und-bevoelkerung Accessed 2024"},{"key":"70_CR19","unstructured":"Statistisches Bundesamt (Destatis) (2019) Statistisches Jahrbuch 2019"},{"key":"70_CR20","unstructured":"World Health Organization (2025) International Classification of Diseases (ICD) - Cause of death. https:\/\/www.who.int\/standards\/classifications\/classification-of-diseases\/cause-of-death Accessed 2025"},{"issue":"2","key":"70_CR21","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s00103-024-03986-3","volume":"68","author":"S Stolpe","year":"2025","unstructured":"Stolpe S, Kowall B (2025) Todesursachenstatistik\u2013 wie fehlinterpretationen von mortalit\u00e4tsdaten Vermieden Werden. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 68(2):167\u2013175. https:\/\/doi.org\/10.1007\/s00103-024-03986-3","journal-title":"Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz"},{"key":"70_CR22","unstructured":"Federal Institute for Drugs and Medical Devices (2025) Iris software. https:\/\/www.bfarm.de\/EN\/Code-systems\/Collaboration-and-projects\/Iris-Institute\/Iris-software\/_node.html Accessed 2025"},{"key":"70_CR23","unstructured":"Statistische \u00c4mter des Bundes (2022) und der L\u00e4nder: Todesursachenstatistik. https:\/\/www.regionalstatistik.de\/genesis\/online?operation=statistic&levelindex=0&levelid=1708504673419&code=23211#abreadcrumb Accessed 2024."},{"key":"70_CR24","unstructured":"Bundesinstitut f\u00fcr Arzneimittel und Medizinprodukte (2022) ICD-10-WHO - Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme der WHO. https:\/\/www.bfarm.de\/DE\/Kodiersysteme\/Klassifikationen\/ICD\/ICD-10-WHO\/_node.html Accessed 2024"},{"key":"70_CR25","unstructured":"Kroll LE, Schumann M, Hoebel J, Lampert T (2017) Regional health differences\u2013 developing a socioeconomic deprivation index for Germany. Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung"},{"key":"70_CR26","doi-asserted-by":"publisher","first-page":"205031212412695","DOI":"10.1177\/20503121241269599","volume":"12","author":"E Slotina","year":"2024","unstructured":"Slotina E, Ditscheid B, Meissner F, Marschall U, Wedding U, Freytag A (2024) A refined ICD-10 diagnoses-based approach for retrospective analysis of potential palliative care need and coverage in claims data of deceased. SAGE Open Med 12:20503121241269599. https:\/\/doi.org\/10.1177\/20503121241269599","journal-title":"SAGE Open Med"},{"key":"70_CR27","unstructured":"Robert Koch Institut (2024) Mortality and causes of death. https:\/\/www.rki.de\/EN\/Topics\/Noncommunicable-diseases\/Health-in-the-course-of-life\/Mortality-causes-of-death\/mortality-and-causes-of-death-node.html Accessed 2025."},{"issue":"1","key":"70_CR28","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12916-017-0860-2","volume":"15","author":"SN Etkind","year":"2017","unstructured":"Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ et al (2017) How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med 15(1):102. https:\/\/doi.org\/10.1186\/s12916-017-0860-2","journal-title":"BMC Med"},{"issue":"7498","key":"70_CR29","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1136\/bmj.330.7498.1007","volume":"330","author":"SA Murray","year":"2005","unstructured":"Murray SA, Kendall M, Boyd K, Sheikh A (2005) Illness trajectories and palliative care. BMJ (Clinical Res ed) 330(7498):1007\u20131011. https:\/\/doi.org\/10.1136\/bmj.330.7498.1007","journal-title":"BMJ (Clinical Res ed)"},{"key":"70_CR30","doi-asserted-by":"publisher","first-page":"1421940","DOI":"10.3389\/fpubh.2024.1421940","volume":"12","author":"M Rodr\u00edguez-G\u00f3mez","year":"2024","unstructured":"Rodr\u00edguez-G\u00f3mez M, Pastor-Moreno G, Ruiz-P\u00e9rez I, Escrib\u00e0-Ag\u00fcir V, Ben\u00edtez-Hidalgo V (2024) Age- and gender-based social inequalities in palliative care for cancer patients: a systematic literature review. Front Public Health 12:1421940. https:\/\/doi.org\/10.3389\/fpubh.2024.1421940","journal-title":"Front Public Health"},{"issue":"12","key":"70_CR31","doi-asserted-by":"publisher","first-page":"e1917043","DOI":"10.1001\/jamanetworkopen.2019.17043","volume":"2","author":"LA Schoenherr","year":"2019","unstructured":"Schoenherr LA, Bischoff KE, Marks AK, O\u2019Riordan DL, Pantilat SZ (2019) Trends in Hospital-Based specialty palliative care in the united States from 2013 to 2017. JAMA Netw Open 2(12):e1917043. https:\/\/doi.org\/10.1001\/jamanetworkopen.2019.17043","journal-title":"JAMA Netw Open"},{"issue":"8","key":"70_CR32","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1056\/NEJMoa1000678","volume":"363","author":"JS Temel","year":"2010","unstructured":"Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA et al (2010) Early palliative care for patients with metastatic non\u2013small-cell lung cancer. N Engl J Med 363(8):733\u2013742","journal-title":"N Engl J Med"},{"issue":"6","key":"70_CR33","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1017\/S1478951513001338","volume":"12","author":"KM Dalgaard","year":"2014","unstructured":"Dalgaard KM, Bergenholtz H, Nielsen ME, Timm H (2014) Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome. Palliat Supportive Care 12(6):495\u2013513. https:\/\/doi.org\/10.1017\/S1478951513001338","journal-title":"Palliat Supportive Care"},{"issue":"1","key":"70_CR34","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1186\/s12913-023-09751-7","volume":"23","author":"D Gesell","year":"2023","unstructured":"Gesell D, Hodiamont F, Bausewein C, Koller D (2023) Accessibility to specialist palliative care services in germany: a geographical network analysis. BMC Health Serv Res 23(1):786. https:\/\/doi.org\/10.1186\/s12913-023-09751-7","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"70_CR35","first-page":"1","volume":"22","author":"M Bl\u00fcmel","year":"2020","unstructured":"Bl\u00fcmel M, Spranger A, Achstetter K, Maresso A, Busse R, Germany (2020) Health Syst Rev Health Syst Transit 22(6):1\u2013272","journal-title":"Health Syst Rev Health Syst Transit"},{"key":"70_CR36","unstructured":"Destatis (2023) Kreisfreie St\u00e4dte und Landkreise nach Fl\u00e4che, Bev\u00f6lkerung und Bev\u00f6lkerungsdichte am 31.12.2023. https:\/\/www.destatis.de\/DE\/Themen\/Laender-Regionen\/Regionales\/Gemeindeverzeichnis\/Administrativ\/04-kreise.html Accessed 2025"}],"updated-by":[{"DOI":"10.1007\/s43999-025-00072-2","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000}}],"container-title":["Research in Health Services &amp; Regions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43999-025-00070-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43999-025-00070-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43999-025-00070-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T05:02:07Z","timestamp":1757221327000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43999-025-00070-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,11]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["70"],"URL":"https:\/\/doi.org\/10.1007\/s43999-025-00070-4","relation":{},"ISSN":["2730-9827"],"issn-type":[{"value":"2730-9827","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,11]]},"assertion":[{"value":"13 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2025","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s43999-025-00072-2","URL":"https:\/\/doi.org\/10.1007\/s43999-025-00072-2","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The following statements should be included under the heading \u201cStatements and Declarations\u201d for inclusion in the published paper. Please note that submissions that do not include relevant declarations will be returned as incomplete.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The database provided by the Federal Statistical Office does not contain any personal data and is therefore open to the public. Although ethical approval is not required, the study was reviewed by the Local Research Ethics Committee of Ludwig-Maximilians-University Munich and a waiver has been granted (reference number 24\u20130533 KB). The database does not contain any personal data and therefore no consent to participate was required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The database does not contain any personal data and therefore no consent to publish was required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The author Daniela Koller is an Editor-in-Chief of \u201cResearch in Health Services & Regions\u201d. She was not involved in the peer-review and handling of the manuscript. The authors declare no other financial or non-financial interests that are directly or indirectly related to the work submitted for publication.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"8"}}